title: Assisted conception, maternal age and breastfeeding: an Australian cohort study.
abstract: OBJECTIVE
  To establish the relationships between age, mode of conception and breastfeeding.
  
  
  METHODS
  Consecutive cohorts of nulliparous women >25 weeks pregnant who had conceived through ART (ARTC) or spontaneously (SC) in three age groups ≤30, 31-36 and ≥37 years were recruited. Data were obtained via telephone interviews and postal questionnaires in late pregnancy and 4 months postpartum. Sociodemographic characteristics, reproductive health, birth and breastfeeding experiences were assessed by study-specific questions. Self-rated general health and symptoms of depression and anxiety were assessed with standardized psychometric instruments. Main outcomes were exclusive breastfeeding at discharge from maternity hospital and 4 months postpartum.
  
  
  RESULTS
  Of 1179 eligible women, 791 (67%) participated; 549 (93%) had singleton infants, provided complete data and were included in analyses. Overall, 37.2% of participants aged ≤30, 33% aged 31-36 and 55.1% aged ≥37 years experienced Caesarean births. Regardless of age, compared with the SC group, ARTC women had twice the rate of Caesareans prior to labour. Controlling for other factors, exclusive breastfeeding rates at hospital discharge and 4 months postpartum were lowest amongst ARTC women who experienced Caesarean prior to labour (p < .001).
  
  
  CONCLUSIONS
  Independent of age, assisted conception increases the risk conferred by Caesarean birth to breastfeeding initiation and maintenance.
authors.affiliation: Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. jane.fisher@monash.edu
authors.forename: Jane
authors.initials: J
authors.lastname: Fisher
authors.forename: Karin
authors.initials: K
authors.lastname: Hammarberg
authors.forename: Karen
authors.initials: K
authors.lastname: Wynter
authors.forename: John
authors.initials: J
authors.lastname: McBain
authors.forename: Frances
authors.initials: F
authors.lastname: Gibson
authors.forename: Jacky
authors.initials: J
authors.lastname: Boivin
authors.forename: Catherine
authors.initials: C
authors.lastname: McMahon
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D019052:Depression, Postpartum / Q000175:diagnosis; D005260:Female; D006306:Health Surveys; D006801:Humans; D007231:Infant, Newborn; D007407:Interviews as Topic; D016015:Logistic Models; D008423:Maternal Age; D015999:Multivariate Analysis; D009517:New South Wales; D018743:Perinatal Care; D011247:Pregnancy; D027724:Reproductive Techniques, Assisted; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014739:Victoria; D014886:Weaning
keywords: Breastfeeding duration; Breastfeeding initiation; Delivery mode